On 19 October, Ms Janne McMahon, founder and executive officer of the Private Mental Health Consumer Carer Network (Australia), and Emeritus Professor Gavin Andrews, recently retired from his role as Professor of Psychiatry at UNSW Sydney, were declared dual winners of the 2018 Australian Mental Health Prize. Ms McMahon has appeared before 10 parliamentary inquiries and has been a member of numerous expert reference groups, committees and working groups. She has been the driver of the development of the Practical guide for working with carers of people with a mental illness and associated resources. She obtained agreement from the Australian Government for the development of the National Health and Medical Research Council (NHMRC) Clinical practice guidelines for the management of borderline personality disorder (BPD) and was also a member of the development committee. She has led the BPD National Training Strategy and lobbied politicians for the funding and establishment of the South Australian BPD Centre of Excellence, where she is a member of the executive steering committee. She has also worked with the Royal Australian and New Zealand College of Psychiatry to develop a consumer and carer guide for BPD. Emeritus Professor Andrews’ research interests began with stuttering and extended to depression, epidemiology and treatment and classification of common mental disorders. He is responsible for preparing the first ever set of clinical practice guidelines in psychiatry and the first National Survey of Mental Disorders which helped to quantify the breadth and scope of mental illness in Australia. Gavin also pioneered online treatment courses, called THIS WAY UP, for a range of issues, including panic, depression, social phobia and generalised anxiety disorder.

Australian PrEP rollout associated with 25% drop in HIV diagnoses

Recent human immunodeficiency virus (HIV) infections in gay and bisexual men in New South Wales have declined by around 25% following the rapid targeted rollout of HIV prevention medication PrEP (pre-exposure prophylaxis), according to Kirby Institute research published in The Lancet HIV. These globally unprecedented reductions provide strong evidence to support the large-scale, targeted provision of PrEP to prevent HIV transmission. The new research, funded by NSW Health, reports the findings from the NSW PrEP trial (called EPIC-NSW), which was launched in March 2016. When taken daily, PrEP is highly effective in preventing HIV transmission in men who have sex with men. The EPIC-NSW trial is the first study globally to measure the impact of PrEP on reducing HIV in a large population. In the year after the trial, statewide new HIV infections in this population decreased from 295 infections in the 12 months prior, to 221 in the 12 months after. These numbers are the lowest on record since HIV surveillance began in 1985. The declines were highest among Australian-born gay and bisexual men (48.7%) and gay and bisexual men living in the “gay suburbs” of Sydney (51.8%) and in NSW outside Sydney (54.2%). Reductions were lower in non-English speaking immigrants, with a smaller 21% decline among those born in Asia, suggesting a need to improve education and promote access to PrEP, particularly among culturally and linguistically diverse men who have sex with men, and those outside the “gay neighbourhoods” of Sydney.

Cervical cancer prevention: 6% of patients not managed by guidelines

In the first Australian study to investigate practitioner compliance with guidelines for initial management of adenocarcinoma in situ (AIS), published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, researchers found that 6% of patients were not managed according to official NHMRC guidelines. The retrospective, population-based cohort study used cases from the 2001–2012 Tasmanian and Western Australia Cervical Screening Registries. The management of the cases was contrasted with the recommendations in the NHMRC guidelines for the management of asymptomatic women with screen-detected abnormalities to assess compliance. The results indicate that 21 of 321 patients with an index smear reporting AIS were not managed according to the guidelines. The guidelines recommend that in conservatively managed patients with incompletely excised AIS, a second excision should be performed to obtain clear margins. Importantly, four out of 62 women in this study had invasive disease diagnosed only at the time of a second biopsy. However, 23% of women with a positive AIS margin did not undergo a second excision. The guidelines also state that a hysterectomy should not be performed without a prior biopsy to exclude the presence of invasive cervical carcinoma. In the current study, 17 women with cytology reporting AIS had a hysterectomy as their initial treatment without a prior cervical excision biopsy. Two of these patients had an occult cervical cancer in their hysterectomy specimen. Thus, non-compliance with guidelines resulted in potentially unnecessary and costly additional treatment that carries risks of long term morbidity and may negatively affect quality of life. The authors acknowledge that the study had limitations, including its retrospective design, lack of human papilloma virus data, and absence of colposcopic findings and central histopathology review.